Scott Walker to the poor: You may die or go bankrupt, but you'll always have George Michael!
A couple of weeks ago, right after I left for vacation, both Marco Rubio and Scott Walker finally released "replacement plans" for the ACA. Rubio's was really just an op-ed sort of thing, but Walker's has received quite a bit of attention because it reminds people that he's still running for President and it actually bears some resemblance to an actual policy paper, which is more than anything else the GOP has come up with over the past 6 years.
I was planning on writing up my own analysis of each when I got back, but frankly, I'm too backlogged with other stuff (both ACA and day-job related...I need another vacation from my vacation now...). Plus, many, many others more knowledgable about these things than I have done fantastic writeups already:
- Margot Sanger-Katz in the New York Times: Health Proposals by Walker and Rubio Are Less Concerned About the Poor
Their plans are also much less concerned about ensuring health care access for the poor. In addition to rolling back Obamacare, both would also reduce future federal spending on state-administered Medicaid programs.
- Larry Levitt (of the Kaiser Family Foundation) in the L.A. Times: Would the GOP's healthcare ideas work? It depends on your definition of 'work.'
Would these Republican approaches work? That depends on your definition of "work."
When compared with the ACA, the Republican plans would enable fewer people to obtain insurance. And, unlike the ACA, none would guarantee that people with preexisting conditions would have access to affordable coverage. By these yardsticks, the Republican proposals are not actually "replacements" for the ACA.
- Jeffrey Young & Jonathan Cohn in the Huffington Post: Scott Walker And The Trouble With Obamacare 'Replacement' Plans
By scrapping President Barack Obama's 2010 health care overhaul, Walker's plan -- which the governor announced this week -- would take away health coverage from some unknowable share of the millions of people who have gained it under Obamacare. It promotes benefits like less regulation and less federal spending on health insurance, as well as cheaper coverage for some young and healthy people. But like all the other Republican “repeal and replace” plans that have appeared in the last few years, Walker's proposal never acknowledges the trade-offs and consequences of these changes.
This is the crux of the dilemma facing Obamacare opponents, now that the law has taken hold in the real world: Their proposals would also create winners and losers, albeit different ones from those created by the Affordable Care Act. There's a pretty significant gap between campaigning against the president's signature law and governing with it in place, and talking points -- no matter how appealing they sound -- often don't meet up with reality.
- Ezekiel J. Emanuel in the Washington Post: Why Republicans’ health-care plans are bad deals for Americans
Two fundamental details about the subsidies inevitably torpedo the Republican plans.
One, Republican subsidies are too meager. Years ago, Stanford economist Vic Fuchs and I proposed eliminating the tax exclusion and combining all health-care spending to give Americans a voucher equivalent to the premium for a basic health package.
But Republicans give far less. In 2008, McCain proposed subsidizing each family $5,000 toward the purchase of health insurance. A few days ago, Walker proposed that subsidies be age-based, as opposed to the Affordable Care Act’s income-based subsidies. For a family of four with parents ages 35 to 49 and two children under 18, the subsidies would be $6,000. (Rubio’s plan did not disclose his level of subsidies.)
Republican presidential candidates are starting to get to the “replace” part of their pledges to repeal and replace Obamacare. Wisconsin Gov. Scott Walker and Sen. Marco Rubio of Florida rolled out plans Tuesday. But with specific policy proposals comes real scrutiny and the risk that Americans won’t like what they see.
That quandary has bedeviled the GOP since the Affordable Care Act passed. Republicans are eager to disparage the law "a sure winner with the base” but hesitant to detail their own alternative. Any policy must also grapple with the new reality created by the Democratic law: upwards of 20 million people newly insured.
Now, if I had written up my own full analysis, I would have gone with a "comparison chart"-style entry, literally listing major features of the ACA side-by-side with Walker and Rubio's plans. Fortunately, John McDonough over at Health Stew has done exactly this!
First, even for a campaign document, these plans are wafer thin, raising far more questions than providing answers. Walker’s plan has just seven pages of substance, and Rubio’s is based on two short op-eds for Fox News and Politico.
Second, there is nothing new or novel – or risky – here. Both rehash long-standing and safe Republican talking points. They provide cover for both candidates to lay claim to having a “serious plan” with seeming protection from conservative attacks – though Walker’s plan provoked a strong rebuke from fellow candidate and Louisiana Governor Bobby Jindal.
Third, the plans reflect the Republican Party’s continuing animus toward lower income Americans. This is most apparent in Walker’s proposal for tax credits based solely on age and not on income. The primary reason Americans don’t have health insurance is income not age – but Walker would provide subsidies to any older person at two and a half times as much as a younger person – virtually ensuring that few of the newly insured under the ACA would be able to take advantage.
Anyway, that finally brings me to today. Again, there's not much for me to add to any of the above, but over at the Washington Post, Greg Sargent has an amusing write-up of Scott Walker's complete inability to articulate how his own "plan" wouldn't do exactly what the ACA does in terms of "wealth redistribution"...except in reverse:
Here’s an early indication of the problem Republicans may face in this regard. Note this exchange between CNBC’s John Harwood and Scott Walker, in which Harwood argues that Walker’s Obamacare replacement would reverse the ACA’s downward redistribution:
HARWOOD: Obamacare redistributed money from high income taxpayers, from healthy people, from younger people, to people who had less money, who were older and sicker. Your repeal would redistribute that money in the other direction. Given the trends of income disparity in the country, why is this the right time for that kind of redistribution?
WALKER: Our system’s purely about freedom. It’s about giving people the freedom. The tax credit goes up by age, not by income. It goes up by age because the credit should be connected to what it actually costs people to get health insurance. It’s not about a redistribution of wealth issue.
We allow people to buy into whatever — give ’em the freedom. We give patients as consumers the freedom to choose where they want to go or — frankly, part of our plan says if you want to pool together your resources as consumers, and pick your own plan, you can do that on your own. You have the freedom to take this tax credit, to take your money and pick where you want to go — or if you want to have health care at all. We don’t have a mandate. We wiped the mandate out. We say you can control your own money, with money for a health savings account. Whether you have your own health care plan through your employer or you buy one individually, it’s all about freedom.
Note that Walker doesn’t deny Harwood’s suggestion that his plan would redistribute resources upwards. He says his plan isn’t about accomplishing this species of redistribution, without addressing whether his plan would do that. (See Jonathan Chait’s piece for the details on why his plan actually would do that.) Walker’s answer is that relaxing Obamacare’s regulations — which he repeatedly describes as “freedom” — is a worthy end in itself.
By my count, that's 6 times that Walker uttered the word "freedom!" in the space of 30 seconds (I actually read the full quote out loud using a stopwatch). Walker's position when it comes to the health and well-being of poor/low-income people, as with every other Republican/Libertarian philosophy, is simple: Here's a nickel, kid; now go away and stop bothering me. You may get sick and die from a lack of treatment, or go bankrupt trying to acquire it...but at least you'll die or go broke knowing that you had the freedom to do so!